The place of preoperative imaging scans in parathyroid surgery

INTRODUCTION: The aim of this article is to evaluate early postoperative results of patients operated for hyperparathyroidism.
METHODS: Demographics, underlying diseases, preoprative localization scans and efficacy of surgical techniques applied were evaluated in patients with hyperparathyroidism, operated by one surgeon between 2014 and 2017.
RESULTS: Mean age of total 14 patients was 56.6 (range, 22-73). The success rate of ultrasonography applied in all patients (USG, 100 %) was 71.4%. Scintigraphy was done in all patients (100 %); localization was wrong in two (14.2%) and false negative ratio was 28.5 % (n=4). Computed tomography and magnetic resonance were used in 17.2 and 28.5%, respectively. Mean preoperative serum calcium level of 11.9 mg/dL (range, 10.6-18.2) was normalized to 8.8 mg/dL (range, 7.1-10.1) in a follow-up of 26 months (range, 6-44). The most common involvements were right lower (n=6, % 50) and left lower glands (n=4, % 33). Most important surgical indications were adenoma (n=12, 85.7 %) and tertiary hyperparathyroidism in kidney transplant patients (n=2, 14.2%). Histopathology revealed adenoma diameter as 1.4 cm (range, 0.5-4). There was no permanent morbidity.
DISCUSSION AND CONCLUSION: Although the importance of noninvasive localization studies for effective surgical treatment of hyperparathyroidism is generally accepted, bilateral neck dissection and intraoperative exploration seem sine qua non.